Electrocautery Dissection and Blunt Dissection for Breast Implants

Hi there-
I also feel strongly that precise cautery dissection has lowered my complication rates and simplified recovery for my patients. I do not think that the procedure takes any longer either.
This is a no brainer.
As for your question about how many surgeons do which, I could not say, but I think time will strengthen the knowledge base and more surgeons will use cautery only technique.

Blunt dissection involves using the finger to sweep around and open up the pocket where the implant is to be placed. Electrocautery dissection is more precise, involving cauterization of the blood vessels in the area to reduce trauma and potential for blood loss. Referred to as bloodless breast augmentation, it also leads to faster recovery times.  

This varies tremendously with each surgeon and with each approach. For example probably 90% of TUBA procedures are done primarily with blunt dissection. Whereas the breast crease approach can be accomplished via a variety of techniques. Electrocautery can also be delivered using bipolar forceps which is a more direct and locatlized application of the energy.

Blunt dissection, by definition, involves ripping the tissues apart blindly while cautery dissection is done under direct vision with precision. Since it also controls bleeding there is less bruising. All of this means faster recovery with less discomfort, though I remain skeptical about the "24 hour return to normal activities" that some claim.

The most important thing about the dissection is to remain as bloodless as possible with whichever technique you use.  I think electrocautery works best.

Great technique question, more like a first year plastic surgery resident type question. As seen in these previous postings the electro cautery dissection is far above any blunt finger or instrument dissection. The recovery, degree of swelling, amount of black and blue (ecchymosis), potential hematoma are much less with the cautery. When we see post augmentation patient I almost can guess the surgeon if from my area who uses blunt dissection. Thanks for a great question.

 
rate and careful dissection that is used in breast surgery, there is a decreased incidence of pain, swelling and post-op bleeding. This is one reason I am not a fan of TUBA surgery.
Dr Edwards

I use both blunt, sharp and electrocautery dissection. I don't find it makes a difference in patient pain. What works for me is the use of a long term anesthetic placed in the pocket prior to inserting the implant. My patients have very few complaints of pain.

Hi Njgirl,
Most surgeons use electrocautery dissection, as it leads to less pain and a more bloodless field. It also leads to less trauma to the tissues and therefore less postoperative swelling and bruising. Good question and good luck!
Dr. Singer

I TOTALLY agree with Dr. Rand. The prime standard bearer for precise pocket dissection with cautery rather than blunt dissection has been Dr. John Tebbetts of Dallas who suffered the scorn of many of our colleagues for his opinions. Myself and many other Plastic surgeons think very highly of him. Those who abandoned blunt dissection and adopted his techniques have greatly improved the quality of our results and our patients' satisfaction.
Aside from increased speed (resulting in bleeding and possibly a higher rate of capsular contracture) there is no advantage to the patient from blunt pocket dissection of the breast implant pockets.
Dr. P. Aldea